Treatment of Seizures and Epilepsy Year 4 Paediatrics Notes

Treatment of Seizures and Epilepsy Year 4 · Paediatrics Collection: 4TH YEAR ALL NOTES / PAEDS / PAEDS 4.3 / Munge / CNS -- Slide 1 Treatment of Seizures and Epilepsy Deciding on Long-Term Therapy After a first seizure, if the risk of recurrence is low, as when the patient has a normal neurodevelopmental status, EEG, and MRI (risk ~ 20%), treatment is usually not started.\n\nIf the patient has an abnormal EEG, MRI, development status, and/or neurologic exam and/or has a positive family history of epilepsy, the risk is higher, and often treatment is started. Slide 2 Other considerations are also important, such as motor vehicle driving status and type of employment in older patients or the parents’ ability to deal with recurrences or AED drug therapy in children.\n The decision is therefore always individualized.\n All aspects of this decision-making process should be discussed with the family. Slide 3 Counseling An important part of the management of a patient with epilepsy is educating the family and the child about the disease, its management, and the limitations it might impose and how to deal with them.\nIt is important to establish a successful therapeutic alliance.\nRestrictions on driving (in adolescents), swimming, and certain sports are usually necessary.\nOften swimming in rivers, lakes, or the sea and underwater diving are prohibited, but swimming in swimming pools may be allowable.\nWhen swimming, even patients with epilepsy that is under excellent control should be under the continuous supervision of an observer who is aware of the condition and capable of lifeguard-level rescue. Slide 4 The physician, parents, and child should jointly evaluate the risk of involvement in athletic activities.\nTo participate in athletics, proper medical management, good seizure control, and proper supervision are crucial to avoid significant risks.\nThe ILAE Task Force on Sports and Epilepsy provides general recommendations to assist with making decisions regarding sports participation in patients with epilepsy.\nSports are grouped into categories based on the potential risk of injury or death to the patient and to bystanders. Slide 5 Group 1 sports are associated with no significant additional risk to patients with epilepsy Include most athletics (excluding pole vaulting), bowling, most collective contact sports such as judo and wrestling, most ground based collective sports (e.g., baseball, basketball, cricket, field hockey, football, rugby), cross country skiing, curling, dancing, golf, and racquet sports, including tennis and table tennis. Slide 6 Group 2 sports are associated with a moderate risk to patients with epilepsy but not to bystanders They include alpine skiing, archery, pole vaulting, biathlon/triathlon/modern pentathlon, canoeing, collective sports that can potentially lead to serious injury (boxing, karate, kickboxing, etc.), cycling, fencing, gymnastics, horse riding, ice hockey, shooting, skateboarding, roller and ice skating, skiing and snowboarding, swimming, water skiing, and weightlifting.\nGroup 3 sports are considered a high risk for the patient and for bystanders They include aviation, climbing, platform and springboard diving, horse racing, motor sports, parachuting and other forms of skydiving, rodeo, scuba diving, ski jumping, solitary sailing, as well as surfing and wind surfing. Slide 7 There has been a shift toward encouraging safe sports participation in patients with epilepsy rather than indiscriminately restricting their participation; but the decision has to be individualized to the patient and his/her family. Counselling is helpful to support the family and to educate them about the resources available in the community. Educational and, in some cases, psychological evaluation may be necessary to evaluate for possible learning disabilities or abnormal behavioral patterns that might coexist with the epilepsy. Slide 8 Education about what to do in case of seizures, the choices of treatment or no treatment and of medications and their side effects, and the potential complications of epilepsy should be provided to the parents and, if the child is old enough, to the child.\n Epilepsy carries a risk of increased mortality rates (two or more times the standardized mortality rates of the general population) and of sudden unexpected death mostly related to the conditions associated with or underlying the epilepsy (e.g., tumor, metabolic diseases), to poor seizure control (e.g., in patients with severe epileptic encephalopathies, or drug-resistant seizures), and to poor compliance with prescribed therapies. Slide 9 Mechanisms of Action of Antiepileptic Drugs AEDs reduce excitability by interfering with the sodium, potassium, or calcium ion channels, by reducing excitatory neurotransmitter release or function, or by enhancing GABAergic inhibition.\nMost medications have multiple mechanisms of action, and the exact mechanism responsible for their activity in human epilepsy is usually not